Los Angeles Anthem Medical Prescription Denial Lawyer

Licensed doctors and other medical professionals in Los Angeles are given prescriptive authority, meaning they can write prescriptions for their patients. You trust that your doctor will provide you with a prescription for the medication that they believe to be the best for you and your condition.

However, your insurance company may not believe that the medication is the best for you and may deny payment for prescription drugs when they deem necessary. You may benefit from the services of a qualified Los Angeles Anthem medical prescription denial lawyer if you believe you were wrongly denied prescription coverage. Let a determined insurance attorney advocate for you.

Off-Label Prescription Drugs in Los Angeles

Sometimes Anthem will deny a prescription drug because it is being prescribed for off-label use. For instance, Reglan is a medication used for acid reflux and other gastrointestinal ailments and is FDA approved for these uses. However, it has also been found that a side effect of Reglan is that it increases milk production on already lactating females. Once discovered, many doctors started prescribing Reglan to increase a new mother’s milk supply.

Off-label means it is being prescribed for something that the manufacturer did not intend it to be used for and that it has not been FDA approved for such use. However, California Insurance Code section 10123.195 requires that insurance companies pay for off-label use of an FDA approved drug if it meets certain conditions. For patients who believe that they meet these conditions, it may be helpful to contact an Anthem medical prescription denial lawyer in Los Angeles for further legal insight.

Furthermore, the Friedman-Knowles Act mandates that health plans pay for experimental treatments that would otherwise be excluded in the plan when an independent medical review reveals that the experimental treatment or drug would be more advantageous than a conventional treatment.

Prescription Drug Coverage Law

As per California Insurance Code 1367.243. (a) (1), insured individuals can be required to try alternative drugs prior to the originally prescribed drug being authorized by the insurance carrier. However, the health insurance plan cannot require that the insured to try and fail more than two medications before they pay for the medication that was originally prescribed.

The only exception to this rule is if research and medical evidence supports using more than two other drugs prior to using the requested prescription. When a health care plan requires step therapy with the trial of various drugs first, the process to authorize exceptions for medical necessities should be expeditious as to not delay care.

Help from a Los Angeles Anthem Medical Prescription Denial Attorney

When a health insurance company denies coverage for a prescription drug, you may be quite worried about your health and your finances. You need to know that you have legal rights when it comes to your health insurance company and their denials.

A Los Angeles Anthem medical prescription denial lawyer can help you fight for the compensation you deserve for this type of denial. Call today to hear more about how an attorney can help patients through medical prescription drug denials.